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SOUTHEAST MISSOURI RESIDENTIAL SERVICES ISL
NPI 1598906372
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Poplar Bluff, MO

Active since March 09, 2009
2351 KANELL BLVD, POPLAR BLUFF, MO 63901(573) 840-9374 Get Directions Write a Review

NPPES record last updated: September 3, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 3, 2020, Aug 26, 2019 (2 updates tracked since 2019).

About Southeast Missouri Residential Services Isl NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST MISSOURI RESIDENTIAL SERVICES ISL (NPI 1598906372) is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Poplar Bluff, Missouri and active in the NPI registry since March 2009. The organization lists Molly Jane Boeckmann, Director Of Administrative Services, as its authorized official.

NPPES Registry Identity

NPI1598906372
Entity TypeOrganization
Primary Taxonomy320900000X
Legal Business NameSTATE OF MISSOURI
Location Address2351 KANELL BLVDPoplar Bluff, MO 63901-4035
Mailing Address1706 E Elm StJefferson City, MO 65101-4130 · (573) 751-3398 · Fax (573) 526-4560
Phone(573) 840-9374
Organization SubpartYes
Authorized OfficialMolly Jane BoeckmannDirector Of Administrative Services · (573) 751-4055
Enumeration DateMarch 9, 2009
Last NPPES UpdateSeptember 3, 20202 updates tracked since enumeration
NPPES CertifiedSeptember 3, 2020
✔ NPI 1598906372 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320900000X
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
2351 KANELL BLVD, Poplar Bluff, MO 63901
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Other Names 1

Doing Business AsSoutheast Missouri Residential Services Isl

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STATE OF MISSOURI
Case Management
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
STATE OF MISSOURI
Intermediate Care Facility, Intellectual Disabilities
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9370
STATE OF MISSOURI
Day Training, Developmentally Disabled Services
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
SOUTHEAST MISSOURI RESIDENTIAL SERVICES
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
STATE OF MISSOURI
Family Medicine
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9370

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is State Of Missouri's NPI number?

The NPI number for State Of Missouri is 1598906372. It was assigned to this organization in the NPPES registry on March 9, 2009. The provider is doing business as Southeast Missouri Residential Services Isl.

Where is State Of Missouri located?

State Of Missouri is located at 2351 Kanell Blvd, Poplar Bluff, MO 63901. The listed phone number is (573) 840-9374.

What is State Of Missouri's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for State Of Missouri was last updated on September 3, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.